167 



r Graham (Capt. G. F.)- Sandfly Fever in Chitral (N. India).— J5n7; 

 - Med. Jl, London, 31st July 1915, pp. 169-170. 



During the three years 1911-13, the author has studied between 

 700 and 800 cases of sandfly fever in its epidemic form in Chitral. 

 So far as India is concerned, this fever is probably not of recent 

 appearance, but has previously passed under various names, as 

 Peshawar fever, or pyrexia of uncertain origin. It appears to be a 

 rare disease in the tropical zone, being much more frequently found 

 in subtropical regions, and especially in stations at the foot of the 

 Western Himalayas. The disease is present throughout the whole 

 of the Peshawar-Chitral Valley at all levels below 7,000 feet. The 

 highest level at which Phlebotomiis was found was 6,500 feet. The 

 disease is strictly limited to the summer months, between May and 

 September, and it is only during these months that sandflies are 

 prevalent. A very dry season appears to favour the spread and 

 severity of the epidemic. During the months from June to August, 

 there is practically no rainfall in Chitral. Heavy rainfall, which 

 occurred on one occasion, appeared to reduce the incidence of the 

 fever somewhat, possiblv by killing off some of the infected sandflies. 

 The cold winter months, when the temperature frequently drops to 

 10° to 15° below freezing point, are most probably survived in the 

 egg-stage. 



Phlfhoiomvs papatasii and P. niiiiutiis both occur in Chitral. Large 

 numbers could be caught daily in the barracks of the forts during the 

 summer months. Owing to their small size, they can easily pass 

 through the meshes of the ordinary mosquito curtain used everywhere 

 in India, which necessitates the use of one of much finer mesh. They 

 exist in large numbers in all buildings, especially on the walls and near 

 the ceilings or the roof during the daytime. 



As regards racial incidence, in Chitral, it is remarkable that Europeans 

 and Gurkhas suffer to the extent of from 60 to 80 per cent., while other 

 members of the garrison, who have previously lived mainly in the plains 

 of the Punjab, are practically free from the fever. The indigenous 

 natives themselves do not appear to suffer from the disease except in 

 early infancy. As a rule, one attack confers immunity against fresh 

 attacks, though this is by no means constant. Experience has proved 

 that if the troops of the garrison can spend the three or four fever 

 months of the hot weather under canvas at an elevation of anything 

 over 7,000 feet not a single case of sandfly fever will occur amongst 

 them, while any troops remaining in the fort, which is situated at an 

 elevation of just under 5,000 feet, will contract the fever to the extent 

 of nearly 80 per cent, during the epidemic season. Very early 

 isolation should be strictly carried out and all cases should be kept 

 under a fine mesh sandfly-proof curtain. A similar curtain should 

 be used by all persons hving in an infected area. The demolition of 

 all unnecessary buildings and old walls, which are ideal haunts for the 

 sandfly, is desirable. Fumigation of barracks has been tried, with 

 temporary good results in some cases, numbers of sandflies having 

 been killed ofE by this means. 



